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This is VAERS ID 198985

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 198985
VAERS Form:
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH 05206A2 / - LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECH 706A2 / - RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / - LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, NAUSEA, HEADACHE, HEART ARREST, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 12/8/2009

VAERS ID: 198985 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH SMITHKLINE BEECHAM 05206A2 / - LA / IM
HEPA: HEP A (HAVRIX) HEP A (HAVRIX) / SMITHKLINE BEECH SMITHKLINE BEECHAM 706A2 / - RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / - LA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia, FEVER, NAUSEA, HEADACHE, HEART ARREST, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


Changed on 9/14/2017

VAERS ID: 198985 Before After
VAERS Form:(blank) 1
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / - UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / - UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / - UNK LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


Changed on 2/14/2018

VAERS ID: 198985 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


Changed on 6/14/2018

VAERS ID: 198985 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


Changed on 8/14/2018

VAERS ID: 198985 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


Changed on 9/14/2018

VAERS ID: 198985 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


Changed on 10/14/2018

VAERS ID: 198985 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:California
Vaccinated:2002-01-04
Onset:2002-01-07
Submitted:2003-03-06
Entered:2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=198985&WAYBACKHISTORY=ON


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